Division of Endocrine Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
J Am Coll Surg. 2011 Jul;213(1):188-94; discussion 194-5. doi: 10.1016/j.jamcollsurg.2011.04.029. Epub 2011 May 20.
Fine needle aspiration (FNA) is accepted as the diagnostic procedure of choice in the management of patients with thyroid nodules. Follicular/Hürthle cell neoplasms have traditionally been grouped under the category of indeterminate FNA results. This study examined the experience with FNA in a large cohort of patients undergoing thyroidectomy before adoption of the Bethesda system for reporting thyroid cytopathology (BSTC) at a single academic medical center.
A retrospective review of prospectively collected data of 797 consecutive patients with dominant nodules >1 cm who underwent FNA and thyroidectomy from 2003 to 2009 was performed. Patients were categorized into groups based on FNA results: malignant, benign, indeterminate, and nondiagnostic. The indeterminate group had FNA results that included follicular neoplasm, Hürthle cell neoplasm, and suspicion of papillary thyroid cancer. FNA results were compared with final histopathology after thyroidectomy.
FNA results included 147 (18%) positive for malignancy, 255 (32%) benign, 358 (45%) indeterminate, and 37 (5%) nondiagnostic. The overall malignancy rate on final histopathology was 369 of 797 (46%). Overall, there was a false positive rate of 2% and false negative rate of 8.6%. Among the 358 indeterminate FNA results, carcinoma was found in 81 (36%) of 223 follicular neoplasms, 18 (36%) of 50 Hürthle cell neoplasms, and 78 (92%) of 85 that were suspicious for papillary thyroid cancer. When FNA was nondiagnostic, cancer was present in 9 of 37 (24%). Among 39 patients with benign FNA who had cancer on final histopathology, 22 of 255 (8.6%) had cancer in the index thyroid nodule, and 81% of cancers were >1 cm.
Patients with FNA and dominant nodules >1 cm, who underwent thyroidectomy, had an overall rate of thyroid malignancy of 46%. There was a cancer prevalence of 8.6% in patients with benign FNA results referred for surgical resection. Despite not yet implementing the BSTC at this medical center, the majority of thyroidectomies were adequately performed for indeterminate FNAs with underlying malignancy.
细针穿刺（FNA）被认为是管理甲状腺结节患者的首选诊断程序。滤泡/Hurthle 细胞肿瘤传统上被归类为不确定的 FNA 结果。本研究在单个学术医疗中心采用甲状腺细胞病理学报告 Bethesda 系统（BSTC）之前，检查了在大量接受甲状腺切除术的患者中 FNA 的经验。
对 2003 年至 2009 年间连续 797 例直径>1 厘米的优势结节进行 FNA 和甲状腺切除术的前瞻性收集数据进行回顾性分析。根据 FNA 结果将患者分为以下几组：恶性、良性、不确定和非诊断性。不确定组的 FNA 结果包括滤泡性肿瘤、Hurthle 细胞肿瘤和甲状腺乳头状癌的可疑。将 FNA 结果与甲状腺切除术后的最终组织病理学进行比较。
FNA 结果包括 147 例（18%）恶性阳性，255 例（32%）良性，358 例（45%）不确定，37 例（5%）非诊断性。797 例患者中最终组织病理学的恶性率为 369 例（46%）。总的来说，假阳性率为 2%，假阴性率为 8.6%。在 358 例不确定的 FNA 结果中，223 例滤泡性肿瘤中有 81 例（36%）发现癌，50 例 Hurthle 细胞肿瘤中有 18 例（36%）发现癌，85 例疑似甲状腺乳头状癌中有 78 例（92%）发现癌。当 FNA 结果为非诊断性时，37 例中有 9 例（24%）发现癌症。在最终组织病理学为良性 FNA 的 39 例患者中，255 例中有 22 例（8.6%）在指数甲状腺结节中发现癌症，81%的癌症>1 厘米。
在接受甲状腺切除术的 FNA 和>1 厘米的优势结节患者中，甲状腺恶性肿瘤的总体发生率为 46%。良性 FNA 结果提示手术切除的患者中有 8.6%的癌症患病率。尽管该医疗中心尚未实施 BSTC，但大多数甲状腺切除术对于有潜在恶性的不确定 FNA 都进行了充分的手术治疗。
